小儿阑尾脓肿的治疗策略

目的探讨小儿阑尾脓肿的治疗策略。方法回顾分析2006年9月～2012年3月65例小儿阑尾脓肿的临床资料。一期腹腔镜阑尾切除术49例,中转开腹阑尾切除2例;7例仅行抗感染治疗;2例超声引导下穿刺置管引流;5例行CT引导下穿刺置管引流。结果腹腔镜阑尾切除术手术时间（64±23）min,术中出血量（13±7）ml;7例因脓肿〈5 cm抗感染治疗11～23 d,平均16.7 d;7例因脓肿〉5 cm穿刺置管引流,其中2例超声引导,5例CT引导。65例随访3～66个月,平均37.4月。14例抗感染治疗及穿刺引流患者中,2例择期行二期腹腔镜阑尾切除术,3例因再发急性阑尾炎急诊行二期腹腔镜阑尾切除术。所有手术患者无腹腔出血及肠漏。1例耻骨上trocar口感染,换药治疗后痊愈。结论合理运用超声及多排螺旋CT检查、影像引导下穿刺及腹腔镜阑尾切除等措施诊治儿童阑尾脓肿,具有安全、创伤小、恢复快等优点,值得临床推广。

Treatment Strategy of Children with Appendiceal Abscess

Objective To explore the treatment strategy of children with appendiceal abscess. Methods A retrospective review of 65 children received treatment for acute appendiceal abscess between September 2006 and March 2012 was carried out. There were 49 cases of first-stage laparoscopic appendectomy, 2 cases of converted open laparotomy, 7 cases of anti-infective therapy, 2 cases of cathetering drainage under ultrasonic guidance, 5 cases of eathetering drainage under CT guidance. Results The duration of laparoscopic appendectomy was （64 ＋ 23）rain and the blood loss was （13 ＋ 7）ml; 7 cases only received anti-infective treatment because of the smaller abscess（ 〈 5 cm） , and the course of treatment was 11 -23 d , with an average of 16.7 d; 7 cases received catheterization drainage because of the larger abscess （ 〉 5 cm）. The 65 cases were followed up for 3 - 66 months, with an average of 37.4 months. Among the 14 patients who received anti-infective therapy and catheterization drainage, 2 of them underwent selective second-phase laparoseopic appendectomy, and 3 of them underwent emergency second-phase laparoscopic appendectomy due to the recurrence of acute appendicitis. All procedures were successfully managed, without hemorrhage or fistula. Suprapubic trocar incision infection occurred in 1 case, and was cured after dressing change. Conclusion Ultrasound, CT guided drainage and laparoscopic appendectomy in the treatment of children with appendiceal abscess have the advantages of safety, minimal invasion and quick recovery.